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Obesity is a condition identified by a Body Mass Index of 30 and above. This condition has a large impact on the fertility of women, along with other health issues, including cardiovascular disease, and diabetes.
Obesity impacts not just the health of a woman but also hampers her chances of conceiving as well as maintaining pregnancy until delivery.
IVF and Obesity: What's the Connection Between Them?
Before we understand the link between IVF and obesity, we should understand that multiple factors influence the success rate of IVF but are not limited to the woman's age, quality of the eggs and sperm, uterus health, and overall lifestyle. Obesity can adversely affect all these factors, which can ultimately reduce the likelihood of achieving a successful pregnancy and live birth.Impact Of Obesity On Female Fertility
- Decrease in ovarian reserve: Obesity has a direct effect on the ovary and oocyte. Obesity causes a decreased number of ovarian follicles and affects oocyte quality. Similarly, human studies demonstrate morphological oocyte abnormalities and decreased oocyte competence with obesity. Oocytes from females with obesity undergoing in vitro fertilisation (IVF) treatment are often smaller compared with their normal weight counterparts, are less likely to complete development post fertilisation, and in 1 study, were noted to have granular cytoplasm. Reduced quality and number of healthy eggs significantly reduce the success rate with IVF.
- Hormonal imbalances: An imbalance in hormones, often worsened by obesity, can impact ovulation and affect how the body reacts to various medications given during the IVF process. Women who are obese are likely to be more prone to resistance to insulin, leading to elevated insulin levels. This might disturb the balance of hormones vital for successful conception. Also, insulin resistance can reduce the effectiveness of fertility medications, decreasing the likelihood of a successful IVF outcome even further.
- Poor quality of embryo: Obesity also impacts the quality of embryos produced during the IVF process. This happens due to the inflammatory substances released by the fat cells, especially those located in the abdominal area. These substances hinder the development of eggs and embryos. Poor-quality embryos might lead to a lower number of embryos being available for transfer or increase the probability of miscarriage.
- Increased risk of miscarriage: As mentioned above, obesity increases the chances of miscarriage, even if the IVF is successful. Several researches indicate that women with a BMI of 30 or above are likely to be at a greater risk of miscarriage during early pregnancy. The rate of miscarriage tends to rise in IVF pregnancies among obese women, which is mainly associated with hormonal imbalances and decreased embryo quality.
- Ovulation problems: Obesity is also associated with various other conditions, such as Polycystic Ovary Syndrome or PCOS, which can obstruct regular ovulation. (Disclaimer: Please note that obesity can worsen symptoms of PCOS but obesity is not the cause of PCOS) When a woman is suffering from PCOS alongside obesity, it decreases the efficiency of the IVF process due to the lower quality of the egg and irregular ovulation cycle.
- Impact on uterine health: Excessive weight can lead to uterine issues, such as changes in endometrial function, which are vital for embryo implantation.
- Decreased implantation rates: Obesity increases the chance of uterine problems like fibroids, which can hinder IVF implantation and lower the chances of a successful pregnancy.
Obesity’s Effect On Male Fertility
For a successful pregnancy, the fertility of males is also vital. Obesity impacts male fertility in the same way just as it impacts female fertility. For males,- Obesity hampers fertility via hormonal imbalances and poor sperm quality.
- Obesity in males results in longer conceiving time due to poor sperm quality.
- Excessive fat leads to cardiovascular issues and improper circulation, which might result in erectile dysfunction
Obesity's Effect on IVF Treatment Procedures
- Ovarian stimulation response: Women with obesity might not respond to ovarian stimulation during the IVF process. The ovaries become less sensitive to the fertility medications that stimulate egg production. This might lead to decreased eggs being recovered during the IVF cycle.
- IVF medication dosage: Women with obesity undergoing IVF require larger doses of fertility medications to stimulate their ovaries much more effectively. However, these higher doses can increase the risk of ovarian hyperstimulation syndrome or OHSS, a serious condition marked by swollen and painful ovaries. This complication can make the IVF procedures more challenging, lowering the success rate.
- Anaesthesia risks during IVF: Obesity raises the risks associated with anaesthesia used during the egg retrieval process. The risk of complications during anaesthesia can hamper the overall safety of IVF procedures for women with a BMI count of 30 and above.
Factors Contributing to the Decreased Success Rates of IVF in Obese Women
- Lifestyle factors: Exercise, diet, and overall lifestyle habits play a significant role in the success of the IVF process. Obesity is often connected to poor lifestyle choices, including unhealthy diet and lack of physical activity, which can decrease the chances of IVF success. Lack of proper physical exercise and poor diet can result in hormonal imbalances, resulting in more difficulty achieving pregnancy via IVF.
- Comorbid conditions: Obesity is often associated with various other medical conditions like diabetes, hypertension, and cardiovascular diseases. These conditions further reduce the chances of a successful IVF outcome.
- Emotional and psychological impact: Obesity often leads to emotional and psychological stress, which can negatively affect fertility. Anxiety, depression, and stress have been linked to poor IVF outcomes and may exacerbate hormonal imbalances and overall reproductive health.
- Medical risks of obesity: Obesity can lead to various medical issues including hypertension, gestational diabetes, preeclampsia, metabolic syndrome, insulin resistance, fatty liver disease, and acid reflux (GERD).
What Can Be Done to Improve IVF Success Rates for Obese Women?
Weight loss before IVF treatment
- Weight loss is one of the most effective ways to improve IVF outcomes in obese women.
- Studies have shown that even a modest 5-10% weight loss can significantly improve ovarian function, hormonal balance, and overall reproductive health.
- Consulting with a healthcare provider to develop a safe and sustainable weight loss plan before undergoing IVF can significantly improve the chances of success.
Healthy lifestyle changes
- A healthy diet of fruits, vegetables, lean proteins, and whole grains can support fertility.
- Regular physical activity helps regulate insulin levels, improve hormone function, and maintain a healthy weight.
- Avoiding smoking and reducing alcohol intake is also crucial for enhancing fertility and IVF outcomes.
Medical support for comorbidities
- Managing comorbidities like diabetes and hypertension is essential for improving IVF success rates.
- Women with obesity should work closely with their doctors to manage these conditions through medications, diet, and lifestyle changes before starting IVF treatment.
Fertility treatments and options
- For some women, bariatric surgery (weight-loss surgery) may be recommended as a way to improve fertility outcomes. Studies have shown that women who undergo bariatric surgery before IVF may experience higher success rates.
- Consulting with a fertility specialist to discuss personalised IVF treatment options is essential for optimising the chances of conception.
- Taking supplements like inositol and folic acid plays a vital role in the fertility of both men and women. Supplements help in improving egg quality and ovary regularity as well as sperm count, semen quality, mobility and decreased DNA fragmentation. They are also important for foetal development.
- Consult a therapist for better stress management and overall mental health, since fertility treatments like IVF can be overwhelming for your mental health. The entire process, including waiting for an outcome can feel like a lot, mentally, so consult a therapist.
Obesity has a significant impact on IVF success rates, influencing everything from egg quality to hormonal balance and overall reproductive health. The good news is that with the right lifestyle changes, medical management, and fertility treatments, women with obesity can improve their chances of success during IVF. Weight loss, healthy eating, regular exercise, and managing comorbidities like diabetes and hypertension can have a profound effect on the outcomes of IVF. Women struggling with obesity and infertility should work closely with fertility specialists to develop a tailored treatment plan for the best chance at a successful pregnancy.
FAQs on The Impact of Obesity on IVF Success Rates
- Does obesity restrict my access to fertility treatments?
Obesity should not be the sole criterion for denying a patient or couple access to any infertility treatment. Individual programs are there to adopt program-specific BMI thresholds solely on the basis of the ability to safely perform oocyte retrievals and other procedures within their clinical environment. Women with obesity are at increased risk of infertility and of developing maternal and fetal complications during pregnancy. Pre-pregnancy counselling for couples with obesity should address the reproductive and maternal-foetal consequences of obesity. - How to improve egg quality for IVF?
To improve egg quality for the IVF process, women have to strictly maintain a healthy diet, exercise regularly, maintain their body’s water level, avoid consuming alcohol and cigarettes, and proper stress & emotion management. Some supplements are also available to improve the egg quality.
